Posterior Sub–Tenon’s Capsule Triamcinolone Injection Combined with Focal Laser Photocoagulation for Diabetic Macular Edema

Tunç, Murat; Önder, Halil İbrahim; Kaya, Murat

doi:10.1016/j.ophtha.2004.12.039

Cited by 50 publications

(32 citation statements)

References 29 publications

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“…This improvement is equivalent to 10 ETDRS letters and comparable to visual outcomes achieved with anti-VEGF therapies. In the current study, STTA was performed simultaneously in 7 eyes to reduce possible transient worsening of DME after laser photocoagulation according to previous reports of combined therapy of STTA and laser photocoagulation [34,35,36]. Although intravitreal injection of triamcinolone acetonide is more effective, the sub-Tenon route was chosen because it is less invasive and the incidence rates of elevated intraocular pressure, cataract progression, and endophthalmitis are lower [37,38].…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Angiography-Guided Focal Laser Photocoagulation for Diabetic Macular Edema

Ogura

Yasukawa²,

Kato³

et al. 2015

Ophthalmologica

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Purpose: To evaluate the usefulness of indocyanine green angiography (ICGA) to detect leaking spots and the effectiveness of ICGA-guided focal laser photocoagulation in eyes with diabetic macular edema (DME). Methods: Ten eyes (8 patients) with diffuse DME diagnosed using fluorescein angiography (FA) and refractory to a sub-Tenon injection of triamcinolone acetonide (STTA), grid laser photocoagulation, or both were enrolled. FA and ICGA were performed using the Heidelberg Retina Angiograph 2. Hyperfluorescent spots on early-phase FA and on early- and late-phase ICGA were superimposed onto the macular thickness map measured by optical coherence tomography (OCT) and counted to calculate the spot density in the area with or without macular edema (ME). ICGA-guided focal laser photocoagulation was carried out. In 7 eyes, STTA was simultaneously performed. The central macular thickness (CRT) and macular volume (MV) were measured by OCT. Results: On early-phase FA, 4.8 ± 2.3 and 2.3 ± 1.5 hyperfluorescent spots/disk area were observed inside and outside the ME, respectively. In contrast, the spot density was significantly decreased to 1.8 ± 0.9 inside the ME and was only 0.3 ± 0.4 outside the ME on late-phase ICGA (p < 0.01). The mean follow-up period after ICGA-guided photocoagulation was 19.0 months. The mean best-corrected visual acuity improved significantly from 0.77 ± 0.34 logarithm of the minimum angle of resolution at baseline to 0.52 ± 0.37 at the last visit (p < 0.01). Both CRT and MV significantly decreased (p < 0.01). Recurrence of DME was observed in 4 eyes: 3 eyes were treatable only with STTA and 1 required additional ICGA-guided laser photocoagulation. Conclusions: ICGA may be useful to detect leaking spots responsible for DME, enabling less invasive focal laser photocoagulation even in some of the eyes with diffuse DME.

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Section: Discussionmentioning

confidence: 99%

Indocyanine Green Angiography-Guided Focal Laser Photocoagulation for Diabetic Macular Edema

Ogura

Yasukawa²,

Kato³

et al. 2015

Ophthalmologica

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“…Several studies have addressed the question whether, instead of an intravitreal injection, a sub-Tenon injection could have the same results as an intravitreal injection by increasing visual acuity while avoiding the risks of an intraocular procedure [60,88,131,322,323,324]. Most of them agree that the sub-Tenon injection results in a lower intraocular concentration and a shorter duration of action compared with the intraocular injection.…”

Section: Discussionmentioning

confidence: 99%

“…Most of them agree that the sub-Tenon injection results in a lower intraocular concentration and a shorter duration of action compared with the intraocular injection. As one of the side effects of a sub-Tenon injection, ptosis and orbital fat prolapse have been reported [324]. …”

Section: Discussionmentioning

confidence: 99%

Intravitreal Triamcinolone

Tao

Jonas

2010

Ophthalmologica

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Background: To provide an update on the intravitreal use of triamcinolone acetonide. Methods: Review of literature regarding triamcinolone-related research. Results: After the introduction of bevacizumab and ranibizumab into clinical practice, intravitreal triamcinolone has lost its leading position as the drug most often injected intravitreally. Due to its properties as a long-acting steroid, triamcinolone has still been used for various conditions such as diffuse diabetic macular edema, retinal vein occlusions, pseudophakic cystoid macular edema, chronic prephthisical ocular hypotony and uveitis, and in combination with bevacizumab or ranibizumab. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected, cataract and postoperative infectious or noninfectious endophthalmitis. Conclusions: Due to its widespread biological effects as a steroid and due to a relatively large therapeutic window, intravitreal triamcinolone has remained in clinical use for a variety of intraocular disorders, and it may be a promising candidate for intravitreal medical combination therapies.

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“…In a similar manner, Cardillo et al [61] reported that the posterior sub-Tenon's capsule injection of triamcinolone can result in an improvement in visual acuity in patients with diffuse diabetic macular edema. Tunc et al [213] reported that posterior sub-Tenon's capsule application of triamcinolone can improve visual outcome in diffuse diabetic macular edema as compared with focal laser treatment. In a similar manner, sub-Tenon injections of triamcinolone acetonide were reported to be effective in the treatment of polypoidal choroidal vasculopathy [214] .…”

Section: Diabetic Macular Edema and Proliferative Diabetic Retinopathmentioning

confidence: 99%

Intravitreal Triamcinolone Acetonide: A Change in a Paradigm

Jonas¹

2006

Ophthalmic Res

149

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Background: Based on experimental studies and clinical observations by Robert Machemer, Gholam Peyman and others, the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of intraocular diseases. Methods and Results: The most widely injected drug so far has been triamcinolone acetonide for various intraocular neovascular and edematous diseases. Comparing the various diseases with respect to effect and side effects of the treatment, the best response in terms of gain in visual acuity has been achieved for intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. In eyes with various types of noninfectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behçet’s disease, visual acuity increased and the degree of intraocular inflammation decreased. Some studies have suggested that intra- vitreal triamcinolone may be useful as an angiostatic agent in eyes with iris neovascularization and proliferative ischemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration, particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high intraocular pressure leading to antiglaucomatous surgery in about 1–2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15–20% in elderly patients within 1 year after injection; postoperative infectious endophthalmitis with a rate of about 1:1,000; noninfectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudoendophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other types of intraocular surgery including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated, if vision redecreases. In nonvitrectomized eyes, the duration of the effect and side effects of a single intravitreal injection of triamcinolone is about 6–9 months for a dosage of about 20 mg, and about 2–4 months for a dosage of 4 mg. It has remained unclear so far, whether and how to remove the solvent agent. In the future, intravitreal triamcinolone may be combined with other antiangiogenic drugs for the treatment of exudative age-related macular degeneration or with neuroprotective drugs for treatment of diabetic retinopathy. Conclusions: Despite an exponentially increasing number of mostly case-series studies, the intravitreal injection of triamcinolo...

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Posterior Sub–Tenon’s Capsule Triamcinolone Injection Combined with Focal Laser Photocoagulation for Diabetic Macular Edema

Cited by 50 publications

References 29 publications

Indocyanine Green Angiography-Guided Focal Laser Photocoagulation for Diabetic Macular Edema

Indocyanine Green Angiography-Guided Focal Laser Photocoagulation for Diabetic Macular Edema

Intravitreal Triamcinolone

Intravitreal Triamcinolone Acetonide: A Change in a Paradigm

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